Aims Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart failure. We aimed to conduct a systematic review of the literature and summarize the performance of mobile health (mHealth) devices in diagnosing and screening for AF. Methods and results We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Forty-three studies met the inclusion criteria and were divided into two groups: 28 studies aimed at validating smart devices for AF diagnosis, and 15 studies used smart devices to screen for AF. Evaluated technologies included smartphones, with photoplethysmographic (PPG) pulse waveform measurement or accelerometer sensors, smartbands, external electrodes that can provide a smartphone single-lead electrocardiogram (iECG), such as AliveCor, Zenicor and MyDiagnostick, and earlobe monitor. The accuracy of these devices depended on the technology and the population, AliveCor and smartphone PPG sensors being the most frequent systems analysed. The iECG provided by AliveCor demonstrated a sensitivity and specificity between 66.7% and 98.5% and 99.4% and 99.0%, respectively. The PPG sensors detected AF with a sensitivity of 85.0–100% and a specificity of 93.5–99.0%. The incidence of newly diagnosed arrhythmia ranged from 0.12% in a healthy population to 8% among hospitalized patients. Conclusion Although the evidence for clinical effectiveness is limited, these devices may be useful in detecting AF. While mHealth is growing in popularity, its clinical, economic, and policy implications merit further investigation. More head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness.

A patient in their 70s with a history of paroxysmal atrial fibrillation and a structurally normal heart was prescribed flecainide, 100 mg twice a day, for rhythm control. The patient presented to the emergency department with complaints of dizziness. Their blood pressure was 60/44 mm Hg, heart rate was 166 beats/min, and oxygen saturation was 100% on ambient air. Serum sodium level was 138 mEq/L; serum potassium level, 4.4 mEq/L; and serum creatinine level, 0.86 mg/dL. The electrocardiogram (ECG) at presentation (Figure 1) showed a regular monomorphic wide complex tachycardia (WCT) at a rate of 160 beats/min.Question: What is the diagnosis?

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